ight years ago, emergency department (ED) personnel at Christiana Hospital recorded the whereabouts of patients in a health information- technology system that required manual entry of all changes in a patient’s location. This non-automated system had served the ED well in the past but had become outdated and unworkable when volume reached 85,000 annual visits in 2003. As the volume surged, the hospital realized it needed an automated system to avoid signifi cant wait times and reduce the percentage of patients who left without been seen (LWBS).

Also, not surprisingly, 20 percent of the time patient loca- tion information recorded in the non-automated system was incorrect. Although that appears low, it meant the 913-bed hospital owned by Wilmington, Del.-based Christiana Care Health System didn’t have the exact location of 50 to 60 out of the 250 to 300 people presenting daily at its ED. Some- times patients were in transit or were moved to a different room after a diagnostic study or procedure, and the new location wasn’t immediately noted. Unaware of the change, staff would direct friends and family members to the wrong room, inconveniencing visitors. To address these issues, increase effi ciency and improve ED throughput, Christiana Hospital began looking to infor- mation technology and learned about a real-time location system (RTLS) from Awarepoint that offered immediately accessible, up-to-date patient location data.

Methodical planning

The hospital realized that the right RTLS could continu- ously track and locate patients and staff in addition to tracking devices and supplies, while also streamlining ED workfl ow. Adopting a deliberate and methodical approach, Christiana planned implementation of the system for a year. It went to great lengths to educate and seek input from every constitu- ency that would be directly impacted or could potentially benefi t from the application, which included the ED, ra- diology, laboratory, bed-management and patient-transport departments. Despite excellent relations between management and the employees and physicians, ED management was concerned

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that some staff members might object because they would be concerned that “Big Brother” was trying to measure their personal productivity. To avoid this perception, they stressed to staff that the goals were to improve staff and patient safety, patient care and effi ciency.

The ED team leading the project emphasized that it wanted to keep staff and their families safe in case they were exposed to infectious conditions, such as meningitis, or dangerous substances, such as anthrax. The staff recog- nized that if such an emergent situation occurred, it would be critical for Christiana to identify and quickly fi nd every employee who was exposed and everyone with whom they had interacted. Additionally, in the beginning, staff members’ locations were only identifi ed when they were in patient care areas – the system wasn’t activated in nursing stations and other locations until later, after the staff requested this expanded capability. The hospital has never activated tracking in the break areas or restrooms.

In 2004, the system, which was interfaced with the labora-

tory, radiology system and bedside management applications, went live. In 2010, order entry was added. Wary employees became instant converts because they realized the value of knowing patients’ locations at any given time. In fact, staff considered RTLS a mission-critical system within hours of go-live, which was driven home when Christiana had to shut down its application 24 hours after roll out due to a hardware problem unrelated to RTLS. Staff immediately told managers that they needed the solution back up right away and were eager to start using it again when it was restored later the same day.

Shortly after implementation, the medical staff – unani- mously and voluntarily – chose to turn on the staff location function for the doctors after they experienced how much time they saved when they were needed for a consult or needed to fi nd a patient or another physician. Nursing and the rest of the employees soon followed suit. Now when patients present at the ED, they are instructed to clip the tracking badges to their clothing. Registrars enter the badge number and patient’s name into the system. Cur- rently, the badges emit infrared signals detected by sensors